Effect of halogen light in fetal stimulation for fetal well-being assessment.

OBJECTIVE: To evaluate the shortening of the time of nonstress test (NST) by using transabdominal fetal stimulation with halogen light. STUDY DESIGN: Experimental research. MATERIAL AND METHOD: The authors enrolled 176 pregnant women between 32 and 42 weeks of gestation indicated for NST at the Division of Maternal Fetal Medicine, Siriraj Hospital, Mahidol University. They were randomly assigned to receive either NST (control) or halogen light stimulation test (LST). The stimulation was performed at the beginning of the test and repeated every 10 minutes until reassuring fetal heart rate (FHR) acceleration was achieved, or up to 3 times. All tracings were interpreted blindly by one investigator at the end of the tests. RESULTS: The mean (+/- SD) duration from starting the test to the first FHR acceleration was not significantly different between the control group and the LST group (5.6 +/- 7.2 and 5.4 +/- 5.2 minutes, respectively). The average testing time (+/- SD) to achieved reactivity was 10.5 +/- 8.8 minutes in the controls and 9.6 +/- 6.7 minutes in the LST group. This was not statistically different. The incidence of nonreactive tests was not significantly different between the LST and the controls (15.9% and 11.4%, respectively). Among the LST subjects, term fetuses and women with BMI < 27 kg/m2 required less time to reach reactivity, 2.4 and 2.3 minutes respectively. CONCLUSION: Transabdominal halogen light stimulation did not shorten the duration of NST in the presented population. However, the presented data suggests that the fetus at term could respond to visual stimulation, especially when the gestational age is more advanced.

Noninvasive diagnosis of fetal anemia and fetal intravascular transfusion therapy: experiences at Siriraj Hospital.

Traditionally, when fetal hydrops are found along with certain markers indicating fetal anemia, fetal blood sampling would be performed through cordocentesis to confirm the diagnosis. This procedure, however comes with an inherent risk of losing the whole pregnancy. When anemia was verified, treatment options were limited and the prognosis was grim. In this article, the authors described their experiences of using prenatal Doppler studies as a noninvasive venue in the diagnosis and treatment of fetal anemia. Once the diagnosis of fetal anemia is made, the patient will be asked to undergo an algorithm to investigate the definite cause of anemia, along with simultaneous ultrasound-guided intravascular fetal transfusion in selected cases. The authors selected two cases of fetal anemia of different etiologies and treatment outcomes to demonstrate the significance of early diagnosis and intervention. Review of the relevant medical literatures and the proposed algorithms were also provided.